- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,734.40 / $17,806.59 / $23,895.00
| Facility | | $10,734.40 | $17,806.59 | $23,895.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,500.27 / $15,500.27 / $15,500.27
| Facility | | $15,500.27 | $15,500.27 | $15,500.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,523.62 / $14,928.54 / $23,886.24
| Facility | | $8,523.62 | $14,928.54 | $23,886.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,814.39 / $14,337.00 / $32,880.48
| Facility | | $8,814.39 | $14,337.00 | $32,880.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,465.04 / $14,070.33 / $20,253.40
| Facility | | $10,465.04 | $14,070.33 | $20,253.40 |